CLINICAL RESEARCH OF DYNAMIC CERVICAL IMPLANT AND CAGE FUSION IN TWO-LEVEL CERVICAL DISC PROTRUSION_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 SIWenteng ¹ , ZHANGHuaguo ² , WANGAiguo ¹ , SUNYibao ¹ , BAIYu ¹

1. Department of Orthopedics, Zhengzhou Orthopedics Hospital, Zhengzhou Henan, 450032, P. R. China;
2. Department of Nursing, Henan Medical College for Staff and Workers;

Corresponding author：

SIWenteng, Email: swteng516@163.com

Keywords：

Cervical intervertebral disc protrusion; Dynamic cervical implant; Cage; Bone graft fusion

DOI：

10.7507/1002-1892.20140014

Video：

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Objective To discuss the safety and effectiveness of combined dynamic cervical implant (DCI) and Cage fusion in the treatment of two-level cervical disc protrusion. Methods Between September 2009 and June 2011, 16 cases of two-level cervical disc protrusion were treated with combined DCI and Cage fusion. Of 16 cases, 10 were male and 6 were female, with a mean age of 44.1 years (range, 37-64 years) and with a mean disease duration of 5.1 years (range, 2-8 years), including 8 cases of cervical myelopathy, 5 cases of nerve root cervical myelopathy, and 3 cases of mixed cervical myelopathy. Radiological results indicated degenerative intervertebral discs and compressed never root or spinal cord. Involved discs included C_3,4 and C_4,5 (1 case), C_3,4 and C_5,6(5 cases), C_4,5 and C_5,6 (3 cases), C_4,5 and C_6,7 (5 cases), and C_5,6 and C_6,7 (2 cases). The neck disability index (NDI), Japanese Orthopedic Association (JOA) score, and visual analogue scale (VAS) were used to evaluate the neurological function and pain relief. The stabilities and activities of involved segments, intervertebral fusion, and displacement of Cages were observed during follow-up. Results Primary healing of incisions was obtained in all cases; no complication of hematoma, infection, cerebrospinal fluid leakage, or neural function damage occurred. All 16 patients were followed up 18 months on average (range, 6-36 months). The cervical X-ray results indicated that the activities of involved segments was (7.8±3.1)°, showing no significant difference (t=0.655, P=0.132) when compared with preoperative value [(7.3±2.6)°]. No implant loosening was observed; slight heterotopic ossification occurred in 1 patient at the posterior rim of intervertebral space. No cage loosening or sinking was seen, and good fusion was achieved. The mean time of fusion was 4.5 months (range, 3-8 months). NDI, JOA, and VAS scores at last follow-up (18.3±5.1, 15.7±1.5, and 3.4±1.8 respectively) were significantly improved (t=2.131, P=0.016; t=3.126, P=0.024; t=6.102, P=0.038) when compared with preoperative scores (49.6±11.3, 12.8±2.0, and 6.7±1.2 respectively). Conclusion A combination of DCI and intervertebral Cage fusion has satisfactory early effectiveness in treatment of two-level cervical intervertebral protrusion for maintaining the stability and activity of cervical vertebrae.

Citation： SIWenteng, ZHANGHuaguo, WANGAiguo, SUNYibao, BAIYu. CLINICAL RESEARCH OF DYNAMIC CERVICAL IMPLANT AND CAGE FUSION IN TWO-LEVEL CERVICAL DISC PROTRUSION. Chinese Journal of Reparative and Reconstructive Surgery, 2014, 28(1): 60-63. doi: 10.7507/1002-1892.20140014 Copy

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2.	Lee MJ,Dumonski M,Phillips FM,et al.Disc replacement adjacent to cervical fusion:a biomechanical comparison of hybrid construct versus two-level fusion.Spine (Phila Pa 1976),2011,36(23):1932-1939.
3.	李冰,王沛,李晖,等.Bryan颈椎间盘置换术与颈前路减压椎间融合术术后疗效的系统评价.中国脊柱脊髓杂志,2009,19(7):497-501.
4.	杨大龙,申勇,曹俊明,等.颈人工椎间盘置换近期并发症分析.中国脊柱脊髓杂志,2008,18(4):249-252.
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14.	李勤,田伟,刘波,等.多节段颈椎人工椎间盘置换术的临床研究.中华医学杂志,2007,87(17):1173-1176.
15.	任先军,初同伟,蒋涛.颈椎间盘置换与相邻节段融合的治疗选择.中华创伤杂志,2011,27(5):418-422.
16.	毛宁方,赵颖川,倪海健,等.颈前路非融合与融合技术联合应用治疗颈椎病.中国脊柱脊髓杂志,2012,22(6):531-535.
17.	Zhang X,Zhang X,Chen C,et al.Randomized,controlled,multicenter,clinical trial comparing BRYAN cervical disc arthroplasty with anterior cervical decompression and fusion in China.Spine (Phila Pa 1976),2012,37(6):433-438.
18.	陈辉,马迅,陈晨.Hybrid手术治疗颈椎病的研究进展.中华骨科杂志,2013,33(8):868-872.
19.	马迅,梅军,冯皓宇,等.Hybrid手术治疗脊髓型颈椎病的临床疗效分析.中华骨科杂志,2013,33(8):792-796.
20.	刘海鹰,许晓诺,王波,等.双节段Hybrid手术治疗颈椎病的临床疗效观察.中华外科杂志,2012,50(3):238-242.

1. Zechmeister I,Winkler R,Mad P.Artificial total disc replacement versus fusion for the cervical spine:a systematic review.Eur Spine J,2011,20(2):177-184.
2. Lee MJ,Dumonski M,Phillips FM,et al.Disc replacement adjacent to cervical fusion:a biomechanical comparison of hybrid construct versus two-level fusion.Spine (Phila Pa 1976),2011,36(23):1932-1939.
3. 李冰,王沛,李晖,等.Bryan颈椎间盘置换术与颈前路减压椎间融合术术后疗效的系统评价.中国脊柱脊髓杂志,2009,19(7):497-501.
4. 杨大龙,申勇,曹俊明,等.颈人工椎间盘置换近期并发症分析.中国脊柱脊髓杂志,2008,18(4):249-252.
5. Pickett GE,Mrrsis DK,Sekhon LH,et al.Effects of a cervical disc prosthesis on segmental and cervical spine alignment.Neurosurg Focus,2004,17(3):E5.
6. Hsu WK.Advanced techniques in cervical spine surgery.J Bone Joint Surg (Am),2011,93(8):780-788.
7. Goffin J,Geusens E,Vantomme N,et al.Long-term follow-up after interbody fusion of the cervical spine.J Spinal Disord Tech,2004,17(2):79-85.
8. Walraevens J,Demaerel P,Suetens P,et al.Longitudinal prospective long-term radiographic follow-up after treatment of single-level cervical disk disease with the Bryan Cervical Disc.Neurosurgery,2010,67(3):679-687.
9. 郝定均,贺宝荣,许正伟,等.Bryan人工颈椎间盘置换术与椎间融合术治疗颈椎病的中期疗效比较.中华骨科杂志,2011,31(1):18-23.
10. 高延征,司文腾,余正红,等.颈椎动态稳定器治疗颈椎间盘突出症的早期临床疗效.中华骨科杂志,2012,32(1):26-31.
11. 丁琛,刘浩,胡韬,等.双节段Bryan人工颈椎椎间盘置换联合双节段融合治疗多节段颈椎椎间盘突出症:5年随访结果.脊柱外科杂志,2011,9(5):288-292.
12. 侯振扬,徐耀增,顾叶,等.颈椎动态稳定器置入非融合颈椎的生物力学分析.中国组织工程研究与临床康复,2011,15(26):4821-4824.
13. 于淼,孙宇,刘忠军,等.相邻双节段颈椎人工椎间盘置换术疗效的初步观察.中国脊柱脊髓杂志,2009,19(1):34-38.
14. 李勤,田伟,刘波,等.多节段颈椎人工椎间盘置换术的临床研究.中华医学杂志,2007,87(17):1173-1176.
15. 任先军,初同伟,蒋涛.颈椎间盘置换与相邻节段融合的治疗选择.中华创伤杂志,2011,27(5):418-422.
16. 毛宁方,赵颖川,倪海健,等.颈前路非融合与融合技术联合应用治疗颈椎病.中国脊柱脊髓杂志,2012,22(6):531-535.
17. Zhang X,Zhang X,Chen C,et al.Randomized,controlled,multicenter,clinical trial comparing BRYAN cervical disc arthroplasty with anterior cervical decompression and fusion in China.Spine (Phila Pa 1976),2012,37(6):433-438.
18. 陈辉,马迅,陈晨.Hybrid手术治疗颈椎病的研究进展.中华骨科杂志,2013,33(8):868-872.
19. 马迅,梅军,冯皓宇,等.Hybrid手术治疗脊髓型颈椎病的临床疗效分析.中华骨科杂志,2013,33(8):792-796.
20. 刘海鹰,许晓诺,王波,等.双节段Hybrid手术治疗颈椎病的临床疗效观察.中华外科杂志,2012,50(3):238-242.

Chinese Journal of Reparative and Reconstructive Surgery

CLINICAL RESEARCH OF DYNAMIC CERVICAL IMPLANT AND CAGE FUSION IN TWO-LEVEL CERVICAL DISC PROTRUSION

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